COVID-19 Screening

Assessment Tool

COVID-19 Symptom Self-Assessment Tool

This self-assessment tool, developed with the BC Ministry of Health, will help determine whether you may need further assessment or testing for COVID-19. You can complete this assessment for yourself, or on behalf of someone else, if they are unable to.

The BC Ministry of Health strongly urges anyone who has symptoms – including a fever, cough, sneezing, sore throat, or difficulty breathing – to self-isolate for 14 days. To protect yourself while out in public, wash your hands frequently and maintain a distance of about 2 metres from others. For more information on COVID-19, refer to HealthLink BC’s COVID-19 website.

Your Name

Date

Are you experiencing any of the following?

• Severe difficulty breathing (e.g. struggling to breathe or speaking in single words)
• Severe chest pain
• Having a very hard time waking up
• Feeling confused
• Losing consciousness

YesNo

*****
These symptoms require emergency medical care. You should call 9-1-1 immediately, or go directly to your nearest emergency department.

Are you experiencing any of the following?

• Mild to moderate shortness of breath
• Inability to lie down because of difficulty breathing
• Chronic health conditions that you are having difficulty managing because of difficulty breathing

YesNo

*****
Please consult your family doctor or nurse practitioner.

You can call 8-1-1 anytime to talk to a nurse at HealthLinkBC and get advice about how you are feeling and what to do next. Pay attention to how you are feeling. If it becomes harder to breathe, you can’t drink anything, or feel much worse, seek urgent medical care at an urgent care clinic or emergency department.

Are you experiencing any of the following?

• Fever (SELF ISOLATE – 14 DAYS)
• Cough
• Muscle aches
• Fatigue
• Sore Throat
• Headache
• Loss of appetite
• Chills
• Runny nose or nasal congestion
• Nausea and vomiting
• Diarrhea
• Loss of sense of smell/taste

YesNo

*****
Please get a COVID-19 test and self-isolate.

Testing Instructions:
Testing is recommended for anyone, including children of any age, with cold, flu or COVID-19-like symptoms, even mild ones. For more information on testing, visit the Testing page.

NEW: Students in kindergarten through grade 12 now have the option to do a swish and gargle test at all collection centres that are seeing children.

Self-Isolation Instructions:
Self-isolate while you wait for your test results so you do not potentially spread the illness to others.

If you are diagnosed with COVID-19, public health will get in touch and give you instructions on how to self-isolate. You will be required to self-isolate for a minimum of 10 days from when your symptoms started.

Coughing may persist for several weeks, so coughing alone does not require you to continue to isolate.

For instructions on what to do after you have received your test results, visit the Testing page.

Self-isolation means staying home and avoiding situations where you could come in contact with others. You may have been exposed to the virus and are at risk for developing COVID-19 and passing it on to others. You should not self-isolate in a place where you will be in contact with vulnerable people, such as seniors and individuals with underlying health conditions.

Self Isolation Reminders:
• Stay at home. Do not go to work, school, or public areas, do not use public transport or taxis.
• Wash your hands or use alcohol-based hand sanitizer often.
• Ask friends or relatives if you require help with buying groceries, other shopping, or picking up medication. Alternatively, you can order groceries and
medication by phone or online.
• Do not have visitors in your home except if they are providing care or delivering goods and supplies, and in that case, maintain a distance of 2 metres.
• Clean and disinfect high-touch surfaces.

Have you travelled to any countries outside Canada (including the United States) within the last 14 days?

YesNo

*****
Please self-isolate for 14 days and self-monitor for symptoms.

As of March 25, 2020 it is mandatory under the Quarantine Act that anyone arriving in British Columbia from outside of Canada self-isolate and monitor for symptoms for 14 days upon their arrival.

There are some individuals who are exempt from this order to provide essential services, but they still need to self-monitor for symptoms. Returning travellers that develop symptoms are also required to self-isolate for at least 14 days or 10 days after onset of symptoms, whichever is longer.

This can be a bit tricky to figure out. Here are some examples:

Example 1: Symptoms appear five days after returning to Canada and last only a couple of days. Self-isolate for 10 additional days from when your symptoms appeared for a total of 15 days.

Example 2: Symptoms appear two days after returning to Canada. Self-isolate for 10 days from onset of symptoms + an additional 2 days for a total of 14 days.

Did you provide care or have close contact with a person with confirmed COVID-19?

Note: This means you would have been contacted by your health authority’s public health team.

YesNo

*****
Please self-isolate for 14 days and self-monitor for symptoms

People who are contacts of a confirmed case, meaning they have been or could have been exposed to the virus but do not have symptoms are required to self-isolate for 14 days since their last contact with the positive person and monitor for symptoms.

Self-Isolation Reminders:
• Stay at home. Do not go to work, school, or public areas, do not use public transport or taxis.
• Wash your hands or use alcohol-based hand sanitizer often.
• Ask friends or relatives if you require help with buying groceries, other shopping, or picking up medication. Alternatively, you can order groceries and
medication by phone or online.
• Do not have visitors in your home except if they are providing care or delivering goods and supplies, and in that case, maintain a distance of 2 metres.
• Clean and disinfect high-touch surfaces.
• Self-isolation can end 14 days after the last contact provided you do not develop any symptoms.

Additional Resources:

If you are not in an emergency, see if you can find an answer in the BC Centre for Disease Control COVID-19 page.

The BC Government has also set up a non-medical provincial support web site for COVID-19 Provincial Support and Information.

For more information on testing, visit the CDC Testing page.

Collection centre finder (Mobile and desktop)

Collection centre finder for Internet Explorer users

Guide for Isolation if you are ill

Guide for caregivers and household members